Urological irrigation-evacuator

ABSTRACT

A urinary bladder irrigation-evacuator includes means for selectively introducing a sterile fluid into a urinary bladder and thereafter withdrawing fluid including tissue, and other particulate matter from the bladder and of depositing said material into a specimen collecting receptacle in which the tissue and other particles of particulate matter, stones, and the like, are accumulated. The withdrawn fluid is filtered and then recirculated to the first mentioned means for subsequent reinjection into the bladder.

United States Patent Rosen 1 July 1, 1975 [54] UROLOGICAL IRRlGATION-EVACUATOR 3,233,609 2/1966 Leucci 128/227 3,429,313 2/1969 Romanelli 128/230 [761 gg m fgf t gg z 511mm, 3,636,940 1/1972 Graulee 128/278 [22] Filed: Oct. 29, 1973 Primary Examiner-Richard A. Gaudet 1 pp NO 410 716 Assistant Examinerl-lenry S1 Layton [52] 1.1.8. C1 128/2 F; 128/231; 128/251; [57]. S

128/278 A urinary bladder lrrigation-evacuator includes means 51 1m. (:1. A61M 7/00 for Selectively introducing a Sterile fluid into a urinary [58] Field of Search 128/2 F 241, 248, 249, bladder and thereafter withdrawing fluid including tis- 128/25O, 273 2787 276, 231 232 230, 328, sue, and other particulate matter from the bladder and 214 B, 235, 251 240; 166/1051 1053 of depositing said material into a specimen collecting 1054., 417/472, 437 receptacle in which the tissue and other particles of particulate matter, stones, and the like, are accumu- [56] References Cited lated. The withdrawn fluid is filtered and then recircu- UNITED STATES PATENTS lated to the first mentioned means for subsequent reinjection into the bladder, 1,493,592 5/1924 Beck 128/231 1,925,230 9/1933 Buckhout 128/231 11 Claims, 11 Drawing Figures x: 5:: 70 E- E 27 I Z I 60 ,1 f 40 g :i 50

UROLOGICAL IRRlGATlON-EVACUATOR BACKGROUND OF THE INVENTION 1. Field of the Invention In the field of urological surgery, the need frequently arises to evacuate, by flushing, pieces of solid or semisolid material from the urinary bladder, such as stones, blood clots, particulate particles such as pieces of tissue, and the like.

The subject invention is directed to an improved device which will enable a surgeon to initially introduce sterile fluid into a body cavity and thereafter withdraw fluid containing foreign matter from the body cavity in such a manner that the foreign matter is deposited within a specimen collection chamber, and wherein the withdrawn fluid is filtered for recirculation or reintroduction into the body cavity free of foreign matter, thereby greatly enhancing the efficiency and utility of the device.

2. Description of the Prior Art Heretofore, the medical profession has utilized a device known in the art as the ELLIK evacuator for effecting irrigation of the urinary bladder. The Ellik evacuator comprises a pair of integrally formed glass chambers disposed in vertical alignment and having a restricted, centrally disposed passageway in open communication between the chambers. The upper chamber is provided with two ports each of which are defined by an outwardly extending hollow projection, one of which is adapted for communication with a manually compressible bulb, the other of which is adapted to be suitably connected to a resectoscope, or the like, to be introduced into the bladder, or other body cavity, to be irrigated.

In use, the upper and lower chambers of the Ellik evacuator and the compressible bulb are initially completely filled with a sterile fluid which is introduced into a body cavity incident to compression of the bulb. Release of the bulb produces a negative pressure resulting in withdrawal of fluid from the body cavity into the upper chamber, the lower chamber and the bulb. Tissue and other particulate particles in the fluid withdrawn from the body cavity which have a specific gravity greater than that of water will tend to settle or gravitate through the opening between the chambers into the lower chamber. However, since actuation of the bulb produces a pronounced swirling action to the fluid in the upper chamber a certain percentage of the evacuated tissue and other foreign material remain in suspension in the fluid of the upper chamber and in the bulb with the result that tissue and other particulate particles are reinjeeted into the body cavity each time the bulb is compressed after its first or initial compression.

When the evacuation process has been concluded and/or in those instances in which it becomes necessary or desirable to empty and refill the Ellik evacuator during an evacuation procedure, the upper chamber is disconnected from the resectoscope and the bulb is removed after which the fluid within the upper and lower chambers is poured into a cloth or other filtering agent on which tissue and other particulate particles which have been flushed from the bladder will be deposited for examination by the surgeon, pathologist and/or laboratory. Thereafter the bulb is reattached and the entire device refilled with a sterile solution, after which the other port is reconnected to the resectoscope in order that the irrigating-evacuating process may be resumed.

1t should be understood that the aforesaid procedure of irrigation, emptying and refilling the evacuator is repeated several times until the bladder or body cavity has been washed free of all loose tissue, stones, and other particulate particles. It will be noted that the tissue, stones and other particulate matter, per se, evacuated from the Ellik device are almost invariably submitted for a laboratory examination, whereby it becomes necessary to transfer such matter to another receptacle in the process of which some can be lost.

US. Pat. No. 1,643,631 discloses a device for irrigating the urinary bladder for removing fragments of stones therefrom, said device including a fluid receptacle from which fluid is introduced into and thereafter collected after being withdrawn from the bladder.

US. Pat. No. 1,925,230 discloses a syringe apparatus having means for introducing fluid from a closed container through a compressible bulb thence through a passageway, and of withdrawing fluid from a body cavity through another conduit which discharges into a wire mesh filter in which particulate matter is strained from the withdrawn fluid which, having passed through the filter, is adapted to be recirculated through the body cavity incident to manipulation of the bulb.

Other prior art US. patents disclosing apparatus for introducing and withdrawing fluids into and from a body cavity are Nos. 3,411,502; 2,044,912; 3,233,609; 3,527,203; 2,188,190; 3,106,204; 3,398,743; 3,626,928; 3,513,849 and 523,345.

None of the aforesaid prior art devices suggest or disclose a urinary bladder irrigation-evacuator as contemplated by the subject invention.

SUMMARY OF THE lNVENTlON The subject invention is directed to a unique urological bladder irrigation-evacuator of the type which includes a specimen collection chamber in the form of a normally closed, transparent compartment which is constructed and arranged in such a manner as to provide a base or support member for the device per se, and which is adapted to receive and retain tissue and other particles of particulate matter including stones, or the like, in fluid withdrawn from a body cavity, to wit, the bladder, or the like. The specimen collection chamber is constructed in such a manner as to enable it to be forwarded directly to a laboratory for examination of the material housed therein; said chamber, in one aspect of the invention, being formed integral with an upstanding handgrip portion, and in another aspect of the invention being selectively removable from an upstanding handgrip portion in which event the contents of the chamber are sealed within the chamber by means of an auxiliary closure member.

Preferably the device includes means to enable a surgeon to have quick and easy access to the foreign or particulate matter housed within the specimen collection chamber, in the event the surgeon should desire to inspect such matter or material during the evacuation procedure.

Likewise, means in the form of an adjustable check valve are provided for enabling the surgeon to accurately control the discharge of excess fluid, blood, and the like, from the specimen collection chamber without necessitating cessation of an irrigation-evacuating operation, and without losing any of the particulate material entrained in the chamber.

In the preferred embodiment of the invention, the device is fabricated from a suitable plastic material capable of being gas sterilized for providing an inexpensive, sterile, yet highly efficient device which may be discarded after use. The subject device embodies simple and highly effective means for positively circulating fluid from a manually operable bulb into a body cavity and of then withdrawing fluid from the body cavity through a conduit which is in open communication with the specimen collection chamber in which tissue and other particulate particles, including stones, are deposited and retained. The fluid thus withdrawn from the body cavity is filtered before being recirculated to the compression bulb, whereby the fluid introduced into the body cavity will, at all times, be substantially, if not completely devoid of tissue and other particulate particles.

The subject device is constructed in such a manner as to facilitate its use by lefthanded and/or righthanded surgeons, with equal facility, thereby enhancing its utility.

A primary object of the present invention is to provide in a urological irrigation-evacuator, means to provide foolproof, positive filtering of the recirculated fluid and to reliably extract foreign matter from the urinary bladder in as short a time, and with as little effort, and as completely as practical.

A further object of the invention is to provide a device which is capable of efficiently collecting the foreign matter evacuated from the urinary bladder in a specimen collection chamber or receptacle which per se can be sent directly to the laboratory, thus eliminating the possiblity of loss of such matter incident to transfer from one receptacle to another.

BRIEF DESCRIPTION OF THE DRAWINGS FIGS. 1 and 2 are perspective views of the subject device illustrating the matter in which it may be used by right and/or left handed persons.

FIG. 3 is a view, partly in vertical section, of the device illustrating its use for introducing fluid into a body cavity.

FIGS. 4 and 5 are exploded views illustrating the structural details of valving members as embodied in the device of FIG; 3.

FIG. 6 is a view somewhat similar to FIG. 3 illustrating its use for withdrawing fluid from a body cavity into the specimen collecting receptacle portion of the device.

FIG. 7 is a perspective view illustrating the manner in which the combination handgrip-fluid conduit portion of the device are releasably secured to the specimen collecting receptacle.

FIG. 8 is a view similar to FIG. 7 illustrating the manner in which a plug is utilized for sealing the contents of the specimen collecting receptacle.

FIG. 9 is a perspective view of a closed or sealed specimen collecting receptacle as delivered in a sterile condition for association with the fluid conduits of the device as in FIGS. 6 and 7, and further illustrating the manner in which the specimens collected in said receptacle are made available-to the laboratory or patholoist.

g FIG. 10 is a sectional view illustrating the details of the check valve-drain assembly of the device.

' PREFERRED EMBODIMENTS OF THE INVENTION With particular reference to the drawings, the nu- I meral l8 designates generally a urinary bladder irrigation-evacuation device which includes a compressible,

LII

fluid reservoir a specimen collecting receptacle and a pair of fluid conduits and which, in FIGS. 1 and .2 collectively constitute a handgrip portion or member 25.

Uniformly satisfactory results have been obtained in those instances in which the fluid reservoir 20 comprises a conventional, fluid-receptive manuallycompressible bulb, or the like.'The specimen collecting receptacle 30 and the fluid conduits 40 and 50 are preferably fabricated of an unbreakable, transparent material, such as, by way of example, high impact plastic, or the like.

With particular reference to FIG. 7, it will be noted that conduits 40 and 50 are housed within the single, elongate, stem or conduit member 60, the interior of which is subdivided by a transverse panel 27 into individual conduit 40 and 50.

As best illustrated in FIG. 4, the upper portion of transverse panel 27 is provided with an opening 29 which is disposed centrally of a plurality of through ports 31. A first flap valve or valving member 70, fabricated from a suitable resilient material, such as, by way of example, rubber or the like, is disposed in overlying relationship with one side surface of ports 31 by means of a mounting stem 72 which terminates in an enlarged headed portion 74 which is adapted to be compressed incident to insertion into the through opening 29 for disposing stern portion 72 within opening 29 and with the enlarged under-surface of headed portion 74 engaging the hole-adjacent portion of transverse panel 27 for securely, though releasably, securing the flap valve in operable relationship with ports 31.

As illustrated in FIG. 5, the lower portion of transverse panel 27 is provided with a plurality of through portholes 80, wherein the diameter or cross-sectional areas of each of the holes is sufficiently small whereby to effectively and efficiently strain or filter tissue and- /or other particles of particulate matter from fluid passing through said holes. A flap valve anchoring aperture 82 is provided through panel 27 centrally of port openings for receiving the mounting stem 72 of a second flap valve or valving member 71. Mounting stem 72 of valving member 71 terminates in an enlarged head portion 74.

With reference now to FIG. 3, it will be noted that the first valve member 70 is constructed and arranged in such a manner as to permit the flow of fluid from reservoir 20, incident to the application of a compressive force on bulb 20, which produces a positive pressure on the fluid within the device, through the upper end of conduit 50, through ports 31 into the upper end of conduit 40 and thence through the outlet-inlet nozzle 42, which is integral with and in open communication with the upper portion of conduit 40. It will be understood that a length of tubing 44 is adapted to telescopically engage nozzle 42 for thereby establishing a suitable fluid connection'between the subject device and a resectoscope (not illustrated), or the like, which is inserted into the interior of a urinary bladder (not illustrated hereinafter referred to as a body cavity. During those periods of time when fluid is thus being introduced from reservoir into a body cavity the second flap valve 71 is closed for effectively preventing the introduction of fluid from conduit 50 into the lower portion of conduit 40 and/or into receptacle 3(1 When a negative pressure is induced on the fluid incident to release of compressive forces on bulb 20, fluid will be withdrawn from a body cavity, through the resectoscope, tubing 44, nozzle 42 into the upper end of conduit 40, downwardly into and through conduit 40 and thence into receptacle 30, as illustrated in FIG. 6. It will be noted that flap valve 70 is closed for precluding the entry of fluid, via ports 31, from the upper end of conduit 4% into the upper end of conduit 50, whereas flap valve 71 is open for permitting fluid which has been filtered through portholes 80 from the lower portion of conduit 40 and/or the receptacle 30) to enter the lower portion of conduit 50, thence up conduit 5 11 into bulb 20.

With particular reference to FIG. 6, the letters A indicate generally foreign substances in the fluid which have been washed from the body cavity, such as, by way of example, particles of tissue, particulate matter, stones, and the like, which are positively drawn and flushed downwardly through conduit 40 and deposited in the specimen collecting receptacle 30.

It should be understood that when using the subject device all portions thereof will be initially completely filled with a sterile fluid. In the event that manipulation of the device should effect the release of additional fluids from the body cavity, in excess of the volumetric capacity of the device, I have provided simple yet highly effective means, in the form of an adjustable, checkdischarge valve indicated generally by the numeral 90 through which excess fluids may be drained or discharged without necessitating cessation of the evacuating procedure. Said valve, see FIG. I0, includes a nozzle 91 having an inlet port 92 in open communication with an outlet port 94 of receptacle 30. In the preferred embodiment of the invention, outlet port 94 is defined by a plurality of portholes each having a diameter or cross-sectional area such as to effectively and efficiently strain or filter tissue or other particles of particulate matter from fluid passing through said holes into port 92. By rotating sleeve 96, the force by which check ball 93 is urged against its seat 97 by spring lltltl) may be varied for thereby enabling the surgeon to dissipate any excess fluid through discharge port I02 of the check-discharge valve. Sleeve 96 may threadably engage nozzle 9ll, as illustrated.

In the preferred embodiment of the invention the combination handgrip-fluid conduit portion is adapted to be securely, though releasably, associated with the specimen collecting receptacle via port 41 in the upper wall 43 of said receptacle. As clearly illustrated in each of FIGS. 3, 6, and 7., the lower end of member 60 is provided with outwardly projecting tongues 45 which are receptive within apertures 47 of a plurality of bayonet-slot sockets 4% provided in upstanding boss 51 which circumscribes port 41. Suitable sealing means, such as, by way of example, an O-ring 53, note FIGS. 3 and 6, may be utilized for effecting a fluid tight seal between the interlocked portions of the combination handgrip-fluid conduit portion 25 and boss SI of the specimen collecting receptacle 3b.

It will be noted that the specimen collecting receptacle 30 comprises a stand or support for the device which, when used, is handled by a surgeon in the manner illustrated in FIGS. I and 2.

After an evacuation technique has been completed the handgrip-fluid conduit portion 25 may be disconnected from the specimen collecting receptacle 30 after which a closure member 93, note FIGS. 8 and 9, is associated with boss Sil for securely closing port 41 for thereby sealing the contents of the specimen collecting receptacle for transport to a laboratory, or the like. Sleeve 96 of the adjustable check-valve would, of course, be turned in such a manner as to firmly urge check ball 93 against its seat for precluding the accidental or unintentional discharge of fluid from receptacle 34) via port 94.

Access to the interior of the specimen collecting receptacle 30, by the surgeon, during an evacuating procedure, may be conveniently effected by means ofa removable closure member lltll.

In FIG. ill, I have disclosed a modification of the subject device wherein each of conduits 40 and 50 of FIGS. 3 and ti constitute individual tubular members Mt) and I54) which are formed integrally with the specimen collecting receptacle I30.

It will be noted that a first flap valve is located within conduit W5 opposite ends of which are in free, open communication with the uppermost ends of conduits I40 and llS'Il. The second flap valve ll7ll is disposed in the lower end of conduit llStl, as illustrated.

It will be understood that the operating characteristics of the device of FIG. III is the same as that for the device of FIGS. 3 and 6, the main difference residing in the fact that conduits Mt) and ISO are separate, rather than nested, as in FIG. 3 and 6, and, since the conduits are integral with the specimen collecting receptacle 13f), the device as forwarded to a laboratory would include a suitable stopper introduced into nozzle 1142 for precluding the accidental or unintentional discharge of fluid from the device of FIG. llll while en route to the laboratory.

From the foregoing, it will be noted that flap valves 7(11! and 117th permit fluid from reservoir Ztl to be discharged under positive pressure via nozzles 42 and 142 into a body cavity during which time valves '71 and 171 are closed for precluding the introduction of fluid from the reservoir into the specimen collecting receptacle 3(1).

When a negative pressure is applied incident to release of bulb 20 fluid containing tissue and other particulate particles is withdrawn from the body cavity into the upper end of conduits 4t) and 14b and particles A which are entrained in the fluid and thereby propelled into the specimen collecting receptacle. Concurrently and simultaneously with such withdrawal of fluid from the body cavity, fluid from conduits 40 and I40 and their associated receptacles 3'0 and 1138), respectively, is filtered and then introduced into the lower end of fluid conduits 54D and llfitl en route back into the fluid reservoir 20, thereby completing one irrigationevacuating cycle of the device.

It should be understood that irrespective of the rate at which fluid is introduced into and then withdrawn from a body cavity the recirculated fluid which is reinjected into the body cavity is, at all times free of particles of foreign matter, such as tissue, particulate particles, stones and the like which have been evacuated 1 7 from the body cavity as the result of a previous irrigation-evacuation cycle. i i

The subjectdevices are adapted to be individually packaged for delivery to an operating room in a sterile, ready-for-use condition. after which they are adapted to be discharged The relationship of the specimen collecting receptacle to other portions of the device is such that literally all of the foreign matter, such as tissue, particulate particles, stones and the like which have been flushed from a body cavity being evacuated are collected and retained in said receptacle where the material is readily available for examination by the surgeon. pathologist and/or laboratory. There is no chance for such material to become lost or misplaced from the time it is initially withdrawn from a body cavity until it has been examined. The fact that all such foreign matter is entrained in the fluid means that all such matter is positively propelled into the specimen receptacle where it is retained.

It will be noted that in the subject device since the fluid withdrawn from a body cavity cannot be recirculated until and unless it is first filtered to remove all for- .eign particles therefrom, the device may be actuated to alternately introduce fluid into and withdraw it from a body cavity for as long a period of time as desired without the need for draining and replenishing the device with additional fluid, as in'the Ellik evacuator.

What is claimed is:

l. A urological irrigation-evacuator for alternately introducing fluid into and withdrawing fluid from a body cavity through a resectoscope, comprising a fluidreceptive, manually compressible bulb; a specimen collecting receptacle; a first fluid conduit one end of which is in open communication with the interior of said receptacle, and the other end of which includes means providing connection to and establishing communication with a resectoscope; a second fluid conduit in substantial parallelism with said first fluid conduit, the upper end of said second conduit having means providing connection to and establishing open communication with said bulb; valve controlled means establishing communication between the upper portions of said conduits; valve controlled means establishing a fluid.connection between the lower portions of said first and second conduits; said valving means being constucted and arranged whereby to preclude transportation of fluid from said bulb to said receptacle via said first conduit during those periods of time when fluid is being transported from said bulb into a body cavity, and to preclude transportation of fluid withdrawn from the body cavity directly into said bulb and second conduit during those periods of time when fluid withdrawn from the body cavity is being transported into said first conduit; and means for filtering particulate matter from fluid transported from the first conduit into said second conduit.

2. A device as called for in claim 1, wherein the specimen collecting receptacle comprises a base or support member for the device.

3. A device as called for in claim 1, wherein the fluid conduits are formed of rigid material, are secured and to and extend upwardly in parallelism from the specimen collecting receptacle. a

4. A device as called for in claim 1, wherein the said fluid conduits are elongate, parallel and rigid whereby to collectively define a handgrip portion adapted to be grasped by a surgeon using the device.

- 5. A device as called for in claim 4, wherein the fluid conduits are detachably secured to the specimen collecting receptacle.

6. A device as called for in claim 5, which includes a closure member adapted to seal the contents of the receptacle therein.

7. A device as called for in claim 4, wherein the fluid conduits are fixed to the specimen collecting receptacle.

8. A device as called for in claim 1, wherein the first conduit includes means providing connection to and establishing open communication with a resectoscope or the like, and wherein the second conduit includes means providing connection to and establishing open communication with said fluidreceptive, manually compressible bulb. I

9. A device as called for in claim 1, wherein the specimen' collecting receptacle includes a relief valve for the discharge of fluid from said receptacle.

10. A device as called for in claim 9, wherein said relief valve includes means operable for rendering said valve selectively inoperable.

ll. A device as called for in claim 1, wherein the specimen collecting receptacle includes a normally closed. access port. 

1. A urological irrigation-evacuator for alternately introducing fluid into and withdrawing fluid from a body cavity through a resectoscope, comprising a fluid-receptive, manually compressible bulb; a specimen collecting receptacle; a first fluid conduit one end of which is in open communication with the interior of said receptacle, and the other end of which includes means providing connection to and establishing communication with a resectoscope; a second fluid conduit in substantial parallelism with said first fluid conduit, the upper end of said second conduit having means providing connection to and establishing open communication with said bulb; valve controlled means establishing communication between the upper portions of said conduits; valve controlled means establishing a fluid connection between the lower portions of said first and second conduits; said valving means being constucted and arranged whereby to preclude transportation of fluid from said bulb to said receptacle via said first conduit during those periods of time when fluid is being transported from said bulb into a body cavity, and to preclude transportation of fluid withdrawn from the body cavity directly into said bulb and second conduit during those periods of time when fluid withdrawn from the body cavity is being tranSported into said first conduit; and means for filtering particulate matter from fluid transported from the first conduit into said second conduit.
 2. A device as called for in claim 1, wherein the specimen collecting receptacle comprises a base or support member for the device.
 3. A device as called for in claim 1, wherein the fluid conduits are formed of rigid material, are secured and to and extend upwardly in parallelism from the specimen collecting receptacle.
 4. A device as called for in claim 1, wherein the said fluid conduits are elongate, parallel and rigid whereby to collectively define a handgrip portion adapted to be grasped by a surgeon using the device.
 5. A device as called for in claim 4, wherein the fluid conduits are detachably secured to the specimen collecting receptacle.
 6. A device as called for in claim 5, which includes a closure member adapted to seal the contents of the receptacle therein.
 7. A device as called for in claim 4, wherein the fluid conduits are fixed to the specimen collecting receptacle.
 8. A device as called for in claim 1, wherein the first conduit includes means providing connection to and establishing open communication with a resectoscope or the like, and wherein the second conduit includes means providing connection to and establishing open communication with said fluidreceptive, manually compressible bulb.
 9. A device as called for in claim 1, wherein the specimen collecting receptacle includes a relief valve for the discharge of fluid from said receptacle.
 10. A device as called for in claim 9, wherein said relief valve includes means operable for rendering said valve selectively inoperable.
 11. A device as called for in claim 1, wherein the specimen collecting receptacle includes a normally closed access port. 